Insurance

The difference between Medicare Part A and Medicare Part B with therapy coverage

Insurance through Medicare can be confusing. Here’s what you need to know about Medicare Part A vs. Medicare Part B when it comes to therapy and other mental health care coverage.

derek lee grow therapy By Derek Lee, VP of Insurance Operations
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Updated on Sep 26, 2024

If you’re eligible for Medicare coverage, you might be wondering about the difference between Medicare Part A and Medicare Part B, as well as the mental health benefits of each.

Medicare is a federal government health insurance program for US adults over 65, some younger people with certain disabilities and conditions.

If you (or someone you care for) fall into these categories, it can be tricky to understand your benefits, including mental health services.

Here’s what you need to know about Medicare A vs. Medicare B for therapy and other mental health care coverage.

Overview of Medicare Part A and Medicare Part B

Medicare coverage consists of multiple parts. Each part has a unique purpose and covers different services.

See the chart below to learn about the differences between Medicare Part A & B for mental health.

Medicare Part A Medicare Part B
Types of services Inpatient care: when you need round-the-clock care and are admitted overnight or for a certain extended period. Outpatient care: when you have an appointment or treatment that you do not need to stay overnight for.
Care setting A general hospital or a psychiatric hospital Outpatient settings (doctor’s offices, therapy offices, clinics, hospital outpatient departments, community mental health centers)
Coverage Mental health treatment while you’re admitted to a general hospital or psychiatric hospital
  • Mental health screenings
  • Psychiatric evaluations
  • Individual therapy
  • Group therapy
  • Family counseling
  • Medication management
  • Partial hospitalization programs
  • Intensive outpatient programs and more
Costs
  • First 60 days: $1,632 deductible
  • Days 61 through 90: $408 per day
  • Days 91 onwards:  $816 per day
  • After you use all lifetime “Reserve Days,” you pay full price
  • $240 deductible
  • After meeting the deductible, you pay 20% of the Medicare-approved cost for service

Medicare eligibility and enrollment

Medicare is different from Medicaid, which provides insurance for people of all ages who generally fall under low-income requirements.

Generally, Medicare is for adults 65 years of age and older. Or, if you’re younger than 65, you might qualify earlier if you have:

If you’re under 65 and want to see if you qualify for early enrollment, contact Medicare directly (1-800-MEDICARE) or contact your local State Health Insurance Assistance Program (SHIP).

Additionally, it’s important to know when to enroll. There are three enrollment periods, including:

Medicare Part A and mental health coverage

Medicare Part A covers all inpatient care related to both mental health and physical health.

Inpatient mental health services

Inpatient mental health services are needed when you need intensive, round-the-clock care for your condition. These services are typically needed for people experiencing severe mental health crises, such as acute psychosis or suicidal ideation. In these cases, close monitoring, a structured environment, and 24/7 comprehensive care are crucial for stabilization and recovery.

Inpatient mental health services covered by Medicare Part A are:

Additionally, your doctor will have to provide certification of necessity – meaning they must certify that the inpatient treatment is medically necessary.

Costs associated

There is a $1,632 deductible associated with Medicare Part A. Pricing is per day that you spend as an inpatient.

Medicare Part B and mental health coverage

If you need general outpatient mental health care, such as therapy or medication management, this is where Medicare Part B comes in handy.

Outpatient mental health services

There are many mental health services covered by medicare. Here are the specific outpatient mental health services that Medicare Part B covers:

Costs associated

Everyone’s exact costs will be a bit different. However, these are the aspects of cost to consider:

Mental health providers and services covered

Part B of Medicare covers services with many types of mental health care providers with different licensures and specialties, including:

Frequency and duration of coverage

Depending on your specific plan, the frequency and total number of sessions may be limited. However, you may be able to get approval for extended care. Call Medicare customer service at 1-800-MEDICARE for more information about your specific plan.

It’s important to make sure you select the best coverage options for you to take care of both your physical and mental health.

On top of Medicare Part A and Medicare Part B, you might also consider adding additional coverage, such as:

Contact your local State Health Insurance Assistance Program (SHIP) or a private insurance agent for help figuring out the best Medicare plan for you.

Finding a therapist who takes medicare

Are you looking for a therapist who accepts Medicare? Grow Therapy can help.

We know finding providers who take Medicare can be hard, so we’re making it easy for you! Grow Therapy can connect you to an in-person or online therapist who takes Medicare ASAP. Just use our Find a Therapist tool, choose your state of residence, and select Medicare as your insurance type.

Affordable mental health care is within reach. Get started today.

FAQs

  • The main difference is that Medicare Part A covers inpatient services (overnight and extended stays) while Medicare Part B covers outpatient care, such as outpatient therapy services or psychiatrist visits.

  • No, it does not. While most people don’t pay a monthly premium for Part A, there is still a $1,632 deductible. Your cost for the first 60 days will be $0 if you have already met your deductible. If you stay between 61 and 90 days, you’ll pay $408 daily. If you stay more than 90 days, you’ll pay $816 per day while using your 60 “reserve days.” After this, you’ll have to pay in full.

  • Mental health services covered by Medicare Part A are inpatient services in general hospitals or psychiatric hospitals.

  • Medicare Part A does not cover any outpatient services, or inpatient stays longer than 150 days. It also doesn’t cover the cost of a private room during your inpatient stay, unless it’s deemed medically necessary.

  • No. Medicare Part B covers emergency room visits.

  • Yes. Medicare Part B specifically covers outpatient services, including outpatient mental health services.

  • After you meet your deductible, you’ll pay a coinsurance of 20% of the total approved cost, as long as your provider is on assignment with Medicare.

  • Any inpatient hospital care is not covered under Medicare Part B.

  • Yes. Under Medicare Part A, you have a lifetime limit for coverage of 190 days of inpatient mental health care. Additionally, whether you’re using Part A or Part B, you must make sure that your providers accept Medicare coverage.

About the author
derek lee grow therapy Derek Lee, VP of Insurance Operations

Derek Lee is Grow Therapy's Vice President of Insurance Operations, overseeing payor relations and success, credentialing and enrollment, new payor launch, revenue cycle management and billing, and insurance operations data analytics.

This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.

Frequently Asked Questions

  • Grow Therapy connects clients, therapists, and insurance companies to make mental healthcare simple to access.

  • We make it easy to find a therapist who looks like you and can support your needs. The right therapist is one who ensures you feel safe and comfortable. If you need help choosing, read these tips or contact our matching team by phone at 786-244-7711. More contact options are available here.

  • We conduct an intensive interview process to ensure our therapists have the skills, training, and experience to help you grow.

  • People who use their insurance save an average of 73% on the cost of therapy. Sessions cost an average of $22 with insurance, but will vary depending on your plan. Get a cost estimate, learn more about how to check your coverage, or contact your insurance company for more details.